HOSPITALS are the preferred choices in the health system, both by policymakers and the populace, due to their grand visibility. But are hospitals that deal with sick people able to deliver the whole spectrum of health services effectively and efficiently? Often ‘medical’ perception prevails over ‘health’ care when ‘medical’ is only a part of overall ‘health’ care. Hospitals represent a medical fraction. Here is a comparative analysis with an integration option.
Health care operates through two main lenses: the medical approach, focused on diagnosing and treating illnesses, and the health approach, which emphasises holistic well-being and prevention. This comparison clarifies their core differences, advantages, and potential synergy.
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Medical approach
ROOTED in the biomedical model, the medical approach defines health as the absence of disease. It uses a structured process: patient complaint, diagnosis through history, examination, tests, treatment, and prognosis. This model centres on treating physical conditions, often reacting to health issues rather than preventing them. Physicians play a dominant role, typically holding authority based on specialised knowledge, although modern trends favour more patient-centred care. However, this method can neglect psychological, social, and environmental factors that impact health.
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Health approach
CONVERSELY, the health approach adopts a proactive, holistic view. It addresses physical, mental, and social well-being, focusing on prevention, healthy living, and the social determinants of health (like environment, education, and income). Emphasising collaboration among diverse professionals — including public health experts and policymakers — it promotes wide-reaching, long-term strategies for population health.
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Key differences
THE medical and health approaches differ significantly in focus, patient approach, scope of intervention, and perspective. The medical approach primarily emphasizes disease diagnosis and treatment, often centring around the physician as the expert in a disease-centred model. In contrast, theÌýÌý approach prioritizes overall well-being, prevention, and the broader determinants of health. It adopts a more patient-centred and holistic view, taking into account an individual’s specific context and needs. While the scope of the medical approach is largely confined to clinical interventions such as medication and surgery, the health approach encompasses a wider range of strategies, including clinical care, lifestyle modifications, environmental considerations, and policy-level actions. Additionally, the medical approach tends to be reactive, addressing immediate health concerns, whereas the health approach is proactive, with a long-term perspective aimed at promoting well-being at both individual and population levels.
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Benefits and drawbacks
THE medical approach offers several significant benefits. It enables quick diagnosis of illnesses and provides targeted treatment for specific diseases, making it essential for managing acute care situations and emergencies. This approach also leverages advanced medical technologies and is grounded in extensive scientific research, which contributes to its effectiveness in clinical settings. However, it also comes with notable drawbacks. The medical approach can sometimes overlook broader social, psychological, and lifestyle factors, focusing primarily on the disease rather than the person. This disease-centred orientation may lead to an over-reliance on medical interventions, which might not adequately address chronic conditions. Additionally, it carries risks such as fragmented care, the potential for medical errors, and high costs, especially if not complemented by preventive strategies.
On the other hand, the health approach brings a broader perspective that emphasizes overall well-being and quality of life. It focuses on prevention, promotes healthy lifestyles, and addresses health disparities, working to achieve greater equity across populations. This approach also considers the broader determinants of health, such as environmental, social, and economic factors, which can make it more cost-effective in the long term. Furthermore, it empowers individuals and communities to take charge of their health. Despite these advantages, the health approach can be challenging to implement due to its complexity and the need for coordination across multiple sectors. It may require substantial initial investments, and the benefits of prevention can be difficult to measure in the short term. Moreover, this approach may not offer immediate solutions for acute conditions, and in some contexts, there could be concerns about excessive government involvement.
The medical approach is undeniably essential for the diagnosis and treatment of acute illnesses and injuries, providing immediate care when it is most needed. However, the health approach offers a more sustainable and comprehensive strategy for improving the overall health and well-being of the population by addressing the underlying causes of illness and promoting preventative measures.
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Importance of integration
THE importance of integrating medical and health approaches within healthcare systems has been growing. By combining the medical model’s diagnostic and treatment strengths with the holistic, preventative focus of the health model, care becomes more comprehensive and effective. Integration leads to better coordination, communication among healthcare providers, improved patient outcomes, higher satisfaction, and a more sustainable, cost-effective system.
Examples of integrated care models include:
Patient-Centred Medical Homes (PCMHs): Focused on coordinated, comprehensive primary care.
Behavioural health integration with primary care: Addressing the strong link between mental and physical health.
One Health approach: Recognising the interconnectedness of human, animal, and environmental health.
In integrated settings, healthcare professionals prioritise collaboration, communication, and patient-centred, evidence-based care while considering the patient’s full context.
However, several challenges impede integration. These are fragmentation between medical specialities and public health sectors; financial and payment model barriers; workforce training gaps, technological hurdles in data sharing and cultural and organisational resistance to change.
Both models are essential. The medical approach addresses urgent health needs, while the health approach builds a foundation for lasting well-being. Integration, though challenging, is key to creating a future healthcare system that is both responsive and sustainable.
Patient-Centred Medical Home (PCMH) is a primary healthcare model designed to deliver comprehensive, coordinated, accessible, and high-quality care that is focused on the patient’s needs. It redefines how primary care is organised and delivered, moving away from reactive, episodic treatment toward proactive, continuous, and preventive care.
Key features of PCMH include:
Patient-centred care: Respecting patients’ preferences, needs, and values, and involving them actively in decision-making.
Comprehensive care: Providing a range of services (preventive, acute, and chronic) to meet the majority of a patient’s healthcare needs.
Coordinated care: Organising patient care across all parts of the healthcare system, including speciality care, hospitals, and home health care.
Accessible services: Shorter waiting times for urgent needs, enhanced in-person hours, and around-the-clock telephone or electronic access.
Commitment to quality and safety: Evidence-based medicine and clinical decision support tools guide shared decision-making with patients and families.Ìý
Benefits of PCMH are improved patient health outcomes, higher patient satisfaction, reduced healthcare costs (mainly through fewer hospitalisations and emergency visits) and better support for managing chronic conditions
ÌýThe PCMH model is widely adopted in countries like the United States, Australia, and parts of Europe, often supported by health policies promoting primary care reform.
Comparison between Patient-Centred Medical Homes and Hospitals
In short PCMH is ‘relationship-based care at the front line’, aiming to prevent hospital visits and hospitals are for ‘critical and advanced care’ when people need urgent, specialised interventions.
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Dr Md Mohsin Ali is a public health and nutrition specialist.
